Provider Demographics
NPI:1134226376
Name:LUMINA CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:LUMINA CHIROPRACTIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-256-2655
Mailing Address - Street 1:1904 EASTWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-256-2655
Mailing Address - Fax:910-256-2358
Practice Address - Street 1:1904 EASTWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-256-2655
Practice Address - Fax:910-256-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902805Medicaid
NC5902805Medicaid